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Papetti L, Amodeo ME, Sabatini L, Baggieri M, Capuano A, Graziola F, Marchi A, Bucci P, D’Ugo E, Kojouri M, Gioacchini S, Marras CE, Nucci CG, Ursitti F, Sforza G, Ferilli MAN, Monte G, Moavero R, Vigevano F, Valeriani M, Magurano F. Subacute Sclerosing Panencephalitis in Children: The Archetype of Non-Vaccination. Viruses 2022; 14:v14040733. [PMID: 35458463 PMCID: PMC9029616 DOI: 10.3390/v14040733] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 12/22/2022] Open
Abstract
Subacute sclerosing panencephalitis (SSPE) is a late complication of measles virus infection that occurs in previously healthy children. This disease has no specific cure and is associated with a high degree of disability and mortality. In recent years, there has been an increase in its incidence in relation to a reduction in vaccination adherence, accentuated by the COVID-19 pandemic. In this article, we take stock of the current evidence on SSPE and report our personal clinical experience. We emphasise that, to date, the only effective protection strategy against this disease is vaccination against the measles virus.
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Affiliation(s)
- Laura Papetti
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (F.G.); (F.U.); (G.S.); (M.A.N.F.); (G.M.); (F.V.); (M.V.)
- Correspondence: (L.P.); (F.M.)
| | - Maria Elisa Amodeo
- Department of Pediatrics, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (M.E.A.); (L.S.)
- Department of System Medicine, Tor Vergata University of Rome, Viale Oxford 81, 00133 Roma, Italy;
| | - Letizia Sabatini
- Department of Pediatrics, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (M.E.A.); (L.S.)
- Department of System Medicine, Tor Vergata University of Rome, Viale Oxford 81, 00133 Roma, Italy;
| | - Melissa Baggieri
- National Measles Reference Laboratory—WHO/LabNet, Department of Infectious Diseases—Istituto Superiore di Sanità (ISS), 00165 Rome, Italy; (M.B.); (A.M.); (P.B.); (E.D.); (M.K.); (S.G.)
| | - Alessandro Capuano
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (F.G.); (F.U.); (G.S.); (M.A.N.F.); (G.M.); (F.V.); (M.V.)
| | - Federica Graziola
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (F.G.); (F.U.); (G.S.); (M.A.N.F.); (G.M.); (F.V.); (M.V.)
| | - Antonella Marchi
- National Measles Reference Laboratory—WHO/LabNet, Department of Infectious Diseases—Istituto Superiore di Sanità (ISS), 00165 Rome, Italy; (M.B.); (A.M.); (P.B.); (E.D.); (M.K.); (S.G.)
| | - Paola Bucci
- National Measles Reference Laboratory—WHO/LabNet, Department of Infectious Diseases—Istituto Superiore di Sanità (ISS), 00165 Rome, Italy; (M.B.); (A.M.); (P.B.); (E.D.); (M.K.); (S.G.)
| | - Emilio D’Ugo
- National Measles Reference Laboratory—WHO/LabNet, Department of Infectious Diseases—Istituto Superiore di Sanità (ISS), 00165 Rome, Italy; (M.B.); (A.M.); (P.B.); (E.D.); (M.K.); (S.G.)
| | - Maedeh Kojouri
- National Measles Reference Laboratory—WHO/LabNet, Department of Infectious Diseases—Istituto Superiore di Sanità (ISS), 00165 Rome, Italy; (M.B.); (A.M.); (P.B.); (E.D.); (M.K.); (S.G.)
| | - Silvia Gioacchini
- National Measles Reference Laboratory—WHO/LabNet, Department of Infectious Diseases—Istituto Superiore di Sanità (ISS), 00165 Rome, Italy; (M.B.); (A.M.); (P.B.); (E.D.); (M.K.); (S.G.)
| | - Carlo Efisio Marras
- Unit of Neurosurgery, Department of Neurosciences, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (C.E.M.); (C.G.N.)
| | - Carlotta Ginevra Nucci
- Unit of Neurosurgery, Department of Neurosciences, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (C.E.M.); (C.G.N.)
| | - Fabiana Ursitti
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (F.G.); (F.U.); (G.S.); (M.A.N.F.); (G.M.); (F.V.); (M.V.)
| | - Giorgia Sforza
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (F.G.); (F.U.); (G.S.); (M.A.N.F.); (G.M.); (F.V.); (M.V.)
| | - Michela Ada Noris Ferilli
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (F.G.); (F.U.); (G.S.); (M.A.N.F.); (G.M.); (F.V.); (M.V.)
| | - Gabriele Monte
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (F.G.); (F.U.); (G.S.); (M.A.N.F.); (G.M.); (F.V.); (M.V.)
| | - Romina Moavero
- Department of System Medicine, Tor Vergata University of Rome, Viale Oxford 81, 00133 Roma, Italy;
- Child Neurology and Psychiatry Unit, Department of System Medicine, Tor Vergata University of Rome, Viale Oxford 81, 00133 Rome, Italy
| | - Federico Vigevano
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (F.G.); (F.U.); (G.S.); (M.A.N.F.); (G.M.); (F.V.); (M.V.)
| | - Massimiliano Valeriani
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (F.G.); (F.U.); (G.S.); (M.A.N.F.); (G.M.); (F.V.); (M.V.)
| | - Fabio Magurano
- National Measles Reference Laboratory—WHO/LabNet, Department of Infectious Diseases—Istituto Superiore di Sanità (ISS), 00165 Rome, Italy; (M.B.); (A.M.); (P.B.); (E.D.); (M.K.); (S.G.)
- Correspondence: (L.P.); (F.M.)
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Bianchi S, Canuti M, Ciceri G, Gori M, Colzani D, Dura M, Pennati BM, Baggieri M, Magurano F, Tanzi E, Amendola A. Molecular Epidemiology of B3 and D8 Measles Viruses through Hemagglutinin Phylogenetic History. Int J Mol Sci 2020; 21:ijms21124435. [PMID: 32580384 PMCID: PMC7352894 DOI: 10.3390/ijms21124435] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 01/15/2023] Open
Abstract
Of the 24 known measles genotypes, only D8 and B3 are responsible for outbreaks in the last years in Europe, Asia, and America. In this study the H gene of 92 strains circulating between 2015 and 2019 in Lombardy, Northern Italy, and 1273 H sequences available in GenBank were analyzed in order to evaluate the genetic variability and to assess the conservation of the immunodominant sites. Overall, in Lombardy we observed the presence of four different B3 and three different D8 clusters, each one of them including sequences derived from viruses found in both vaccinated and unvaccinated subjects. Worldwide, the residue 400 within the H protein, a position located within the main immune epitope, is mutated in all circulating strains that belong to the two globally endemic genotypes, B3 and D8. Our data demonstrate the usefulness of measles virus (MV) H gene sequencing. Indeed, the monitoring the H protein epitopes of circulating strains could be included in the measles laboratory surveillance activities in order to improve and optimize strategies for measles control, as countries go towards elimination phase.
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Affiliation(s)
- Silvia Bianchi
- Department of Biomedical Sciences for Health, University of Milan, via Carlo Pascal 36, 20133 Milan, Italy; (S.B.); (G.C.); (M.G.); (D.C.); (M.D.); (B.M.P.); (A.A.)
| | - Marta Canuti
- Department of Biology, Memorial University of Newfoundland, 232 Elizabeth Ave., St. John’s, NL A1B 3X9, Canada;
| | - Giulia Ciceri
- Department of Biomedical Sciences for Health, University of Milan, via Carlo Pascal 36, 20133 Milan, Italy; (S.B.); (G.C.); (M.G.); (D.C.); (M.D.); (B.M.P.); (A.A.)
| | - Maria Gori
- Department of Biomedical Sciences for Health, University of Milan, via Carlo Pascal 36, 20133 Milan, Italy; (S.B.); (G.C.); (M.G.); (D.C.); (M.D.); (B.M.P.); (A.A.)
| | - Daniela Colzani
- Department of Biomedical Sciences for Health, University of Milan, via Carlo Pascal 36, 20133 Milan, Italy; (S.B.); (G.C.); (M.G.); (D.C.); (M.D.); (B.M.P.); (A.A.)
| | - Marco Dura
- Department of Biomedical Sciences for Health, University of Milan, via Carlo Pascal 36, 20133 Milan, Italy; (S.B.); (G.C.); (M.G.); (D.C.); (M.D.); (B.M.P.); (A.A.)
| | - Beatrice Marina Pennati
- Department of Biomedical Sciences for Health, University of Milan, via Carlo Pascal 36, 20133 Milan, Italy; (S.B.); (G.C.); (M.G.); (D.C.); (M.D.); (B.M.P.); (A.A.)
| | - Melissa Baggieri
- Department of Infectious Diseases, National Reference Laboratory for Measles and Rubella, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161 Rome, Italy; (M.B.); (F.M.)
| | - Fabio Magurano
- Department of Infectious Diseases, National Reference Laboratory for Measles and Rubella, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161 Rome, Italy; (M.B.); (F.M.)
| | - Elisabetta Tanzi
- Department of Biomedical Sciences for Health, University of Milan, via Carlo Pascal 36, 20133 Milan, Italy; (S.B.); (G.C.); (M.G.); (D.C.); (M.D.); (B.M.P.); (A.A.)
- Coordinated Research Center “EpiSoMI”, University of Milan, via Carlo Pascal 36, 20133 Milan, Italy
- Correspondence:
| | - Antonella Amendola
- Department of Biomedical Sciences for Health, University of Milan, via Carlo Pascal 36, 20133 Milan, Italy; (S.B.); (G.C.); (M.G.); (D.C.); (M.D.); (B.M.P.); (A.A.)
- Coordinated Research Center “EpiSoMI”, University of Milan, via Carlo Pascal 36, 20133 Milan, Italy
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Magurano F, Baggieri M, Marchi A, Bucci P, Rezza G, Nicoletti L. Mumps clinical diagnostic uncertainty. Eur J Public Health 2019. [PMID: 28633302 DOI: 10.1093/eurpub/ckx067] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background During recent years, various mumps outbreaks have occurred among populations vaccinated for mumps worldwide. In Italy, improving routine coverage with two doses of measles, mumps and rubella (MMR) vaccine is one of the key strategies to eliminate measles and rubella. To monitor the effect of the vaccination programme on the population, the surveillance of these vaccine-preventable diseases has been implemented. This provided the opportunity to evaluate the accuracy of the clinical diagnosis of those diseases, including mumps. In fact, vaccinated children may develop a variety of diseases caused by a series of different viruses [Epstein-Barr virus (EBV), parainfluenza virus types 1-3, adenoviruses, herpes virus and parvovirus B19] whose symptoms (i.e. swelling of parotid glands) may mimic mumps. For this reason, laboratory diagnosis is essential to confirm clinical suspicion. Methods The accuracy of clinical diagnosis of mumps was evaluated by differential diagnosis on EBV in Italy, a country at low incidence of mumps. This retrospective study investigated whether the etiology of 131 suspected mumps cases with a negative molecular/serological result for mumps virus, obtained from 2007 to 2016, were due to EBV, in order to establish a diagnosis. Results Differential diagnosis revealed a EBV positivity rate of 19.8% and all cases were caused by EBV type 1. Conclusions This study confirms the importance of a lab based differential diagnosis that can discriminate between different infectious diseases presenting with symptoms suggestive of mumps and, in particular, emphasize the importance to discriminate between mumps and EBV-related mononucleosis.
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Affiliation(s)
- Fabio Magurano
- National Reference Laboratory for Measles and Rubella, Department of Infectious Diseases, National Institute of Health, Rome, Italy
| | - Melissa Baggieri
- National Reference Laboratory for Measles and Rubella, Department of Infectious Diseases, National Institute of Health, Rome, Italy
| | - Antonella Marchi
- National Reference Laboratory for Measles and Rubella, Department of Infectious Diseases, National Institute of Health, Rome, Italy
| | - Paola Bucci
- National Reference Laboratory for Measles and Rubella, Department of Infectious Diseases, National Institute of Health, Rome, Italy
| | - Giovanni Rezza
- Department of Infectious Diseases, National Institute of Health, Rome, Italy
| | - Loredana Nicoletti
- National Reference Laboratory for Measles and Rubella, Department of Infectious Diseases, National Institute of Health, Rome, Italy
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Magurano F, Baggieri M, Mazzilli F, Bucci P, Marchi A, Nicoletti L. Measles in Italy: Viral strains and crossing borders. Int J Infect Dis 2018; 79:199-201. [PMID: 30445191 DOI: 10.1016/j.ijid.2018.11.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 11/05/2018] [Accepted: 11/06/2018] [Indexed: 11/16/2022] Open
Abstract
In 2017, Italy experienced one of the largest outbreaks of measles in recent years, with 5404 notified cases and 4347 confirmed cases. A further 2029 cases were notified during the first 6 months of 2018, and 1516 of them were laboratory-confirmed. The B3 and D8 genotypes were identified as those responsible for the outbreak. Possible transmission routes can be established by monitoring the circulating measles virus strains in support of the national health authorities to warn people and travellers.
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Affiliation(s)
- Fabio Magurano
- National Reference Laboratory for Measles and Rubella - Department of Infectious Diseases, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy.
| | - Melissa Baggieri
- National Reference Laboratory for Measles and Rubella - Department of Infectious Diseases, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy.
| | - Francesca Mazzilli
- National Reference Laboratory for Measles and Rubella - Department of Infectious Diseases, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy.
| | - Paola Bucci
- National Reference Laboratory for Measles and Rubella - Department of Infectious Diseases, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy.
| | - Antonella Marchi
- National Reference Laboratory for Measles and Rubella - Department of Infectious Diseases, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy.
| | - Loredana Nicoletti
- National Reference Laboratory for Measles and Rubella - Department of Infectious Diseases, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy.
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- Measles and Rubella Italian Reference Laboratory Network: Antonella Amendola (University of Milan, Italy); Fausto Baldanti (IRCCS Policlinico San Matteo Foundation, Pavia, Italy); Maria Rosaria Capobianchi (INMI "Lazzaro Spallanzani", Rome, Italy); Maria Chironna (University of Bari, Italy); Pierlanfranco D'Agaro (University of Trieste, Italy); Tiziana Lazzarotto (University of Bologna, Italy); Katia Marinelli (United Hospital of Ancona, Italy); Andrea Orsi (University of Genoa, Italy); Giorgio Palù (University of Padova, Italy); Fabio Tramuto (University Hospital of Palermo, Italy)
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Adamo G, Sturabotti G, Baccolini V, de Soccio P, Prencipe GP, Bella A, Magurano F, Iannazzo S, Villari P, Marzuillo C. Regional reports for the subnational monitoring of measles elimination in Italy and the identification of local barriers to the attainment of the elimination goal. PLoS One 2018; 13:e0205147. [PMID: 30356247 PMCID: PMC6200208 DOI: 10.1371/journal.pone.0205147] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 09/20/2018] [Indexed: 01/07/2023] Open
Abstract
Although most countries in the WHO European Region were verified in 2017 as having interrupted endemic measles transmission, nine countries were still endemic. Among these, Italy accounted for the second highest number of measles cases reported in Europe in 2017. The elimination of measles is verified at national level by each country's National Verification Committee (NVC) through the production of an Annual Status Update (ASU). Since in Italy decentralization has led to an inhomogeneous implementation of immunization strategies among the 21 administrative Regions, the Italian NVC proposed that measles elimination should also be documented at the subnational level through regional ASUs and Synthetic Regional Reports (SRRs). The regional ASUs and the SRRs for 2014, 2015 and 2016 were produced and appraised by the NVC to evaluate the Regions' performances in each individual year as well as over the whole period. A specific analysis of vaccination coverage, including official immunization data for 2017, was performed. Moreover, the measles epidemic of 2017 was examined. Firstly, in the period 2014-2016, low immunization rates were registered in most Regions. Sixty-three per cent of southern Regions reported rates below the national mean and an overall low-quality performance. The approval of Italy's mandatory vaccination law in 2017 resulted in a marked increase in vaccination coverage; however, this increase was not homogeneous among Regions. Secondly, more than 50% of Regions did not report any supplemental immunization activity (SIA) for the period 2014-2016. Thirdly, from 2014 to 2016, fewer than one-third of Regions improved their reporting of outbreaks. Finally, over the study period, only two Regions reached the target required by the WHO for measles laboratory investigations. In countries with decentralized health policies, subnational monitoring can help identify local barriers to measles elimination. In Italy it has highlighted the need for further SIAs and a stronger surveillance system.
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Affiliation(s)
- Giovanna Adamo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Giulia Sturabotti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Valentina Baccolini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Pasquale de Soccio
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Grazia Pia Prencipe
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Antonino Bella
- Department of Infectious Diseases, National Institute of Health, Rome, Italy
| | - Fabio Magurano
- National Reference Laboratory for Measles and Rubella, National Institute of Health, Rome, Italy
| | - Stefania Iannazzo
- Infectious Diseases and International Prophylaxis Office, Ministry of Health, Rome, Italy
| | - Paolo Villari
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Carolina Marzuillo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
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Tramuto F, Maida CM, Pojero F, Colomba GME, Casuccio A, Restivo V, Vitale F. Case-based surveillance of measles in Sicily during 2012-2017: The changing molecular epidemiology and implications for vaccine strategies. PLoS One 2018; 13:e0195256. [PMID: 29617454 PMCID: PMC5884552 DOI: 10.1371/journal.pone.0195256] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 03/19/2018] [Indexed: 12/26/2022] Open
Abstract
Following the indication of the World Health Organization, a national plan for the elimination of measles was approved in Italy and this included the improvement of the molecular surveillance of measles viruses and the interruption of indigenous transmission of the disease. Nevertheless, large outbreaks continue to occur in almost all regions of the country, including Sicily. Here we describe the epidemiology and molecular dynamics of measles viruses as a result of the measles surveillance activity carried out by the "Reference Laboratory for Measles and Rubella" in Sicily over a 5-year period. Biological samples of 259 suspected measles cases were tested for viral RNA detection and a total of 223 (86.1%) were classified as laboratory confirmed. The median age of confirmed measles cases was 21.0 years and about half of them were adults aged 19 years and older. Overall, one-third of the patients showed clinical complications and these latter were more common among adults than children (44.9% vs. 25.7%). The vast majority of measles cases were unvaccinated (94.2%, n = 210). The phylogenetic analysis of 221 measles virus nucleotide sequences revealed sporadic detections of genotypes D4 and H1, while endemic circulation of genotypes D8 and B3 was documented. Genotype D8 was associated with epidemics occurred between 2013 and 2016, whereas genotype B3 was more recently introduced into Sicily characterizing the current measles outbreak. The results of this study confirm the autochthonous co-circulation of viral variants belonging to different genotypes during the study period, and emphasizes the need of measles surveillance programmes in order to investigate the viral dynamics, the pathways of disease transmission, and to eventually adapt the development of successfull vaccine formulations.
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Affiliation(s)
- Fabio Tramuto
- Department of Health Promotion Sciences and Mother-Child Care “G. D’Alessandro” – Hygiene section, University of Palermo, Palermo, Italy
- Clinical Epidemiology Unit, University Hospital “Paolo Giaccone”, Palermo, Italy
| | - Carmelo Massimo Maida
- Department of Health Promotion Sciences and Mother-Child Care “G. D’Alessandro” – Hygiene section, University of Palermo, Palermo, Italy
- Clinical Epidemiology Unit, University Hospital “Paolo Giaccone”, Palermo, Italy
| | - Fanny Pojero
- Department of Health Promotion Sciences and Mother-Child Care “G. D’Alessandro” – Hygiene section, University of Palermo, Palermo, Italy
| | - Giuseppina Maria Elena Colomba
- Department of Health Promotion Sciences and Mother-Child Care “G. D’Alessandro” – Hygiene section, University of Palermo, Palermo, Italy
| | - Alessandra Casuccio
- Department of Health Promotion Sciences and Mother-Child Care “G. D’Alessandro” – Hygiene section, University of Palermo, Palermo, Italy
| | - Vincenzo Restivo
- Department of Health Promotion Sciences and Mother-Child Care “G. D’Alessandro” – Hygiene section, University of Palermo, Palermo, Italy
| | - Francesco Vitale
- Department of Health Promotion Sciences and Mother-Child Care “G. D’Alessandro” – Hygiene section, University of Palermo, Palermo, Italy
- Clinical Epidemiology Unit, University Hospital “Paolo Giaccone”, Palermo, Italy
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Anello P, Cestari L, Baldovin T, Simonato L, Frasca G, Caranci N, Grazia Pascucci M, Valent F, Canova C. Socioeconomic factors influencing childhood vaccination in two northern Italian regions. Vaccine 2017; 35:4673-4680. [DOI: 10.1016/j.vaccine.2017.07.058] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 06/16/2017] [Accepted: 07/18/2017] [Indexed: 01/23/2023]
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8
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Magurano F, Baggieri M, Filia A, Del Manso M, Lazzarotto T, Amendola A, D'Agaro P, Chironna M, Ansaldi F, Iannazzo S, Bucci P, Marchi A, Nicoletti L. Towards measles elimination in Italy: Virological surveillance and genotypes trend (2013-2015). Virus Res 2017; 236:24-29. [PMID: 28522332 DOI: 10.1016/j.virusres.2017.05.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 05/10/2017] [Accepted: 05/12/2017] [Indexed: 11/25/2022]
Abstract
In accordance with the goal of the World Health Organization Regional Office for Europe, the Italian National Measles and Rubella Elimination Plan aimed to interrupt indigenous measles transmission in Italy by the end of 2015. However, from 2013 to 2015, Italy experienced high measles burden with 4902 measles cases (49.3% laboratory-confirmed) reported to the enhanced measles surveillance system (cumulative incidence in the triennium reference period: 2.4/100,000 population). The measles elimination goal was not reached. Laboratory surveillance of measles circulating genotypes is performed by the Measles and Rubella National Reference Laboratory (NRL) at the Italian National Institute of Health (Istituto Superiore di Sanità - ISS), in Rome. Samples received from 1 January 2013-31 December 2015 were analysed. Those positive for measles genome by molecular tests were sequenced and phylogenetically analysed. Phylogenetic analysis performed by NRL identified that genotypes D4 and D8 were endemic and co-circulated in 2011-2013: study results show that genotype D4 disappeared during 2013. Sporadic cases were associated to genotype B3 during 2011-2013, which became endemic in Italy during 2014 and co-circulated with D8 until 2015. Sporadic cases were found belonging to genotypes D9 and H1 all over the period in exam. Similar trend has been observed in European WHO Region.
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Affiliation(s)
- Fabio Magurano
- National Reference Laboratory for Measles and Rubella, Department of Infectious Diseases, National Institute of Health, Rome, Italy.
| | - Melissa Baggieri
- National Reference Laboratory for Measles and Rubella, Department of Infectious Diseases, National Institute of Health, Rome, Italy.
| | - Antonietta Filia
- Department of Infectious Diseases, National Institute of Health, Rome, Italy.
| | - Martina Del Manso
- Department of Infectious Diseases, National Institute of Health, Rome, Italy.
| | - Tiziana Lazzarotto
- DIMES, Operative Unit of Clinical Microbiology, Laboratory of Virology St. Orsola-Malpighi General Hospital, University of Bologna, Bologna, Italy.
| | - Antonella Amendola
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
| | - Pierlanfranco D'Agaro
- Department of Medical, Surgical and Health Sciences, University of Trieste, Italy; Institute for Maternal and Child Health-IRCCS "Burlo". Garofolo", Trieste, Italy.
| | - Maria Chironna
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Italy.
| | | | - Stefania Iannazzo
- Infectious Diseases and International Prophylaxis Office, Ministry of Health, Rome, Italy.
| | - Paola Bucci
- National Reference Laboratory for Measles and Rubella, Department of Infectious Diseases, National Institute of Health, Rome, Italy.
| | - Antonella Marchi
- National Reference Laboratory for Measles and Rubella, Department of Infectious Diseases, National Institute of Health, Rome, Italy.
| | - Loredana Nicoletti
- National Reference Laboratory for Measles and Rubella, Department of Infectious Diseases, National Institute of Health, Rome, Italy.
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Filia A, Amendola A, Faccini M, Del Manso M, Senatore S, Bianchi S, Borrini BM, Ciampelli A, Tanzi E, Filipponi MT, Piccirilli G, Lazzarotto T, Pascucci MG, Baggieri M, Magurano F. Outbreak of a new measles B3 variant in the Roma/Sinti population with transmission in the nosocomial setting, Italy, November 2015 to April 2016. ACTA ACUST UNITED AC 2017; 21:30235. [PMID: 27240004 DOI: 10.2807/1560-7917.es.2016.21.20.30235] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 05/20/2016] [Indexed: 11/20/2022]
Abstract
A measles outbreak occurred from November 2015 to April 2016 in two northern Italian regions, affecting the Roma/Sinti ethnic population and nosocomial setting. Overall, 67 cases were reported. Median age of 43 cases in three Roma/Sinti camps was four years, nosocomial cases were mainly adults. The outbreak was caused by a new measles virus B3.1 variant. Immunisation resources and strategies should be directed at groups with gaps in vaccine coverage, e.g. Roma/Sinti and healthcare workers.
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Affiliation(s)
- Antonietta Filia
- Infectious Diseases Epidemiology Unit, Istituto Superiore di Sanità, Rome, Italy
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10
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Measles re-emergence in Northern Italy: Pathways of measles virus genotype D8, 2013-2014. INFECTION GENETICS AND EVOLUTION 2016; 48:120-126. [PMID: 27989661 DOI: 10.1016/j.meegid.2016.12.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 12/02/2016] [Accepted: 12/13/2016] [Indexed: 11/22/2022]
Abstract
Molecular surveillance and advanced phylogenetic methods are important tools to track the pathways of Measles virus (MV) genotypes, provide evidence for the interruption of endemic transmission and verify the elimination of the disease. The aims of this study were to describe the genetic profile of MV genotype D8 (D8-MV) strains circulating in Northern Italy (Lombardy Region) during the 2013-2014 period and to analyze the transmission chains and estimate the introduction time points using a phylogenetic approach. Forty-four strains of D8-MV identified from 12 outbreaks and 28 cases reported as sporadic were analyzed. Molecular analysis was performed by sequencing the highly variable 450nt region of the N gene of MV genome (N-450), as recommended by the WHO. Phylogenetic analyses and tree time-scaled reconstruction were performed with BEAST software. We could trace back the transmission pathways that resulted in three chains of transmission, two introductions with limited spread (two familiar outbreaks), and two single introductions (true sporadic cases). The D8-Taunton transmission chain, which was involved in 7 outbreaks and 13 sporadic cases, was endemic during the studied period. Furthermore, two novel local variants emerged independently in March 2014 and caused two transmission chains linked to at least 3 outbreaks. Overall, viral diversity was high and strains belonging to 5 different variants were identified. The results of this study clearly demonstrate that multiple lineages of D8-MV co-circulated in Northern Italy. Measles can be considered a re-emerging disease in Italy and additional efforts are necessary to achieve measles elimination goal.
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11
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Piccirilli G, Chiereghin A, Pascucci MG, Frasca G, Zuntini R, Ferrari S, Gabrielli L, Landini MP, Lazzarotto T. Molecular detection and genetic characterization of circulating measles virus in northern Italy. J Clin Virol 2016; 81:34-42. [PMID: 27310466 DOI: 10.1016/j.jcv.2016.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 05/26/2016] [Accepted: 05/30/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND Laboratory diagnosis of measles virus (MV) infection and genetic characterization of circulating MV play an essential role in measles surveillance, allowing proper interventions to interrupt endemic transmission. OBJECTIVES We describe results obtained using serological and molecular methods to confirm MV infection among suspected cases reported in a large region in the north of Italy during 2010-2014 and the genotyping of the MV strains detected. STUDY DESIGN Three hundred seventy-two samples (361 urine and 11 oral fluids) were tested for MV-RNA detection. In 281 cases, the serological results for MV-IgM detection were also available. RESULTS A total of 276 cases were classified as confirmed measles and MV-RNA detection resulted positive for 239/276 cases. Nucleotide sequence analysis revealed sporadic cases of genotypes D9 and different circulations of endemic MV strains (D8, D4 and B3). CONCLUSIONS This data suggests that there is still an unvaccinated part of the population maintaining the endemic circulation of MV in Italy.
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Affiliation(s)
- Giulia Piccirilli
- Operative Unit of Clinical Microbiology, Laboratory of Virology, St. Orsola-Malpighi University Hospital, Via Massarenti 9, 40138 Bologna, Italy.
| | - Angela Chiereghin
- Operative Unit of Clinical Microbiology, Laboratory of Virology, St. Orsola-Malpighi University Hospital, Via Massarenti 9, 40138 Bologna, Italy.
| | | | - Gabriella Frasca
- Public Health Unit Emilia-Romagna Region, Viale Aldo Moro 21, 40127 Bologna, Italy.
| | - Roberta Zuntini
- Unit of Medical Genetics, Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy.
| | - Simona Ferrari
- Unit of Medical Genetics, St. Orsola-Malpighi University Hospital, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy.
| | - Liliana Gabrielli
- Operative Unit of Clinical Microbiology, Laboratory of Virology, St. Orsola-Malpighi University Hospital, Via Massarenti 9, 40138 Bologna, Italy.
| | - Maria Paola Landini
- Department of Specialised, Experimental, and Diagnostic Medicine, Operative Unit of Clinical Microbiology, Laboratory of Virology, St. Orsola-Malpighi University Hospital, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy.
| | - Tiziana Lazzarotto
- Department of Specialised, Experimental, and Diagnostic Medicine, Operative Unit of Clinical Microbiology, Laboratory of Virology, St. Orsola-Malpighi University Hospital, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy.
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12
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Urone N, Colomba C, Ferraro D. Characterization of measles virus strains circulating in Southern Italy (Palermo area, Sicily) between 2010 and 2011. INFECTION, GENETICS AND EVOLUTION : JOURNAL OF MOLECULAR EPIDEMIOLOGY AND EVOLUTIONARY GENETICS IN INFECTIOUS DISEASES 2016; 38:117-121. [PMID: 26723918 DOI: 10.1016/j.meegid.2015.12.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 12/14/2015] [Accepted: 12/22/2015] [Indexed: 06/05/2023]
Abstract
Measles virus (MV) was classified in 24 genotypes that show a distinct geographic distribution. Genotypes contain multiple distinct lineages. In 2011 large outbreaks of measles occurred in Italy and in many European countries. Aims of this study are to analyze the intra-genotype variability and to follow the importation and the spread of new MV strains in Sicily. A fragment of 450 bps of MV C-terminal nucleoprotein was sequenced from sera of 73 Sicilian patients with symptomatic measles infections, occurred between 2010 and 2011. Five MV strains were D4 genotype and 68 were D8 genotype. The MV/D4 sequences were related to MV/D4-Enfield variant. Two lineages of MV/D8 genotypes, related to MV/D8-Villupuram variant and to a strain found in Birmingham in 2006 respectively, were identified. This is the first study that reports the co-circulation of different MV genotypes and lineages in Sicily suggesting multiple origins of the outbreak that occurred during 2010 and 2011 years.
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Affiliation(s)
- Noemi Urone
- (a)Sezione di Microbiologia "A.Chiarini", Italy
| | - Claudia Colomba
- Sezione di Malattie Infettive-Dipartimento di Scienze per la Promozione della Salute e Materno Infantile "G D'Alessandro" Università di Palermo, Italy
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13
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Magurano F, Baggieri M, Bordi L, Lalle E, Chironna M, Lazzarotto T, Amendola A, Baldanti F, Ansaldi F, Filia A, Declich S, Iannazzo S, Pompa MG, Bucci P, Marchi A, Nicoletti L. Measles in Italy: Co-circulation of B3 variants during 2014. J Med Virol 2015; 88:1081-5. [PMID: 26496509 DOI: 10.1002/jmv.24416] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2015] [Indexed: 11/09/2022]
Abstract
In 2013, the majority of the WHO/EUR countries reported an annual incidence of >1 case per one million population indicating that the elimination target is far from being met. Thus, there is the urgent need to uncover and analyze chains of measles virus (MV) transmission with the objective to identify vulnerable groups and avoid possible routes of introduction of MV variants in the European population. The analysis of molecular epidemiology of MV B3 strains identified in 2014 has shown that four different variants co-circulated in Italy, including the strain that caused a cruise-line ship outbreak at the beginning of the year.
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Affiliation(s)
- Fabio Magurano
- Department of Infectious Parasitic and Immune-Mediated Diseases, National Reference Laboratory for Measles and Rubella, National Institute of Health, Rome, Italy
| | - Melissa Baggieri
- Department of Infectious Parasitic and Immune-Mediated Diseases, National Reference Laboratory for Measles and Rubella, National Institute of Health, Rome, Italy
| | - Licia Bordi
- Laboratory of Virology, National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy
| | - Eleonora Lalle
- Laboratory of Virology, National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy
| | - Maria Chironna
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Bari, Italy
| | - Tiziana Lazzarotto
- DIMES, Operative Unit of Clinical Microbiology, Laboratory of Virology St. Orsola-Malpighi General Hospital, University of Bologna, Bologna, Italy
| | - Antonella Amendola
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Fausto Baldanti
- Department of Microbiology and Virology, Molecular Virology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Antonietta Filia
- Infectious Diseases Epidemiology Unit, National Institute of Health, Rome, Italy
| | - Silvia Declich
- Infectious Diseases Epidemiology Unit, National Institute of Health, Rome, Italy
| | - Stefania Iannazzo
- Infectious Diseases and International Prophylaxis Office, Ministry of Health, Rome, Italy
| | - Maria Grazia Pompa
- Infectious Diseases and International Prophylaxis Office, Ministry of Health, Rome, Italy
| | - Paola Bucci
- Department of Infectious Parasitic and Immune-Mediated Diseases, National Reference Laboratory for Measles and Rubella, National Institute of Health, Rome, Italy
| | - Antonella Marchi
- Department of Infectious Parasitic and Immune-Mediated Diseases, National Reference Laboratory for Measles and Rubella, National Institute of Health, Rome, Italy
| | - Loredana Nicoletti
- Department of Infectious Parasitic and Immune-Mediated Diseases, National Reference Laboratory for Measles and Rubella, National Institute of Health, Rome, Italy
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